Provider Demographics
NPI:1619163177
Name:DAVID A MOSBORG MD
Entity Type:Organization
Organization Name:DAVID A MOSBORG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSBORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-276-1446
Mailing Address - Street 1:1895 KINGSLEY AVE STE 703
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4410
Mailing Address - Country:US
Mailing Address - Phone:904-276-1446
Mailing Address - Fax:904-276-1448
Practice Address - Street 1:1895 KINGSLEY AVE STE 703
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4410
Practice Address - Country:US
Practice Address - Phone:904-276-1446
Practice Address - Fax:904-276-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061356207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF22725Medicare UPIN
FLK3741Medicare PIN